Saturday, December 29, 2018

Prevention is like “Mom and Apple Pie.” Everyone agrees that prevention is crucially important, everyone agrees we should support prevention, and there are a growing number of studies which show that prevention is the best investment our society can make – to stop sexual violence before anyone is harmed. Yet even for professionals and advocates in our field, prevention is often an afterthought. In the public domain, especially in the middle of the emotional reactions to yet one more horrifying case, one fact often gets lost: Sexual abuse is preventable.

How do we change that balance and integrate prevention into all of our work? How do we convince the public and key stakeholders that prevention is important?

This research began five years ago with a deep dive into analyzing current narratives about sexual violence and prevention through the lens of news coverage. They then learned how experts and field leaders communicate and think about prevention through structured interviews and listening sessions around the country, including at ATSA board meetings and annual conferences. Finally, with the help of Goodwin Simon Strategic Research, they conducted extensive public opinion research to identify which stories, values, data points, and storytellers could help illustrate for different audiences that preventing sexual abuse and assault is not only possible, but a concrete and important part of our public, community and family response.

Sexual violence prevention is more than just education. A comprehensive approach includes tertiary prevention, the core of what ATSA members do every day. However, ATSA also has information that is key to primary prevention – but how do members communicate that crucial information?

These resources describe keyframes that ATSA members can use to create an effective prevention message – a message that helps the listener understand their complex emotional reactions and engage in the idea of primary prevention as a necessary solution. In brief, an effective message about prevention should:

·Evoke shared values with the audience

·Acknowledge any of the audience’s negative feelings and lingering doubts

·Describe the speaker’s journey (our own understanding) of how we began to understand prevention

·Articulate the problem clearly

·Name at least one concrete solution and illustrate success.

These messages, and the guide’s “rule of the road” fit well to the recent ATSA Journal statement asking ATSA members to use person-first language and to take the time to describe the behaviors of our clients, rather than labeling them as “sex offenders”, the exact problematic behaviors we work to change.

The list looks may look daunting – but the ATSA Prevention Committee has already developed some of these key elements in our framing document on how ATSA members can talk about prevention (See ATSA’s Framing Document). That frame evokes the shared values that guide our work – preventing sexual abuse to keep our communities safer. The Prevention Committee’s infographics (See ATSA’s Infographic Documents) also articulate the problem and what ATSA can offer in terms of a solution. ATSA has a unique perspective to offer about preventing the perpetuation of sexual violence – a critical element in preventing first-time harm.

BMSG also challenges each of us to articulate our own journey towards understanding the need for prevention. If you are reading this blog posting, you care about prevention – can you also talk about why you care and can you tell someone how you got there? What was the “turning point” where you started to believe prevention was possible, or when you decided to pursue this work?

With all of the passion that ATSA members bring to our work, our everyday conversations about what we do and WHY we do this work to make our communities safer it is essential that we do not do this alone but that we also involve our contacts, colleagues and peers. Let them know that prevention is possible.

Monday, December 17, 2018

An extraordinary trend in recent criminological and psychological research, which has gone largely unnoticed in public discussions of policy and practice, is that a person’s risk of re-offence goes down the longer they are in the community. Given the very high stakes of public protection, risk management and human rights, it’s time these findings receive wider public discussion.

In 2010, Michael Caldwell published a meta-analysis of studies of juveniles in which he noted that “Studies that examine sexual recidivism during adolescence find monthly sexual recidivism rates that are more than 4 times higher than those found in studies that rely only on adult recidivism records. Neither the level of secured placement (community, residential, or secured custody) nor the use of arrest versus conviction as an outcome significantly influences sexual recidivism rates”. In other words, adolescents re-offend less as they enter adulthood, which reinforces the criminological research on general recidivism (by leading authors such as David Farrington and Terrie Moffitt) and desistence (for example, Fergus MacNeill, Shadd Maruna, and Beth Weaver).

In 2014, Karl Hanson, Andrew Harris, L. Maaike Helmus, and David Thornton published a study examining the re-offence rates of adults and found that “Overall, the risk of sexual recidivism was highest during the first few years after release, and decreased substantially the longer individuals remained sex offence-free in the community. This pattern was particularly strong for the high-risk sexual offender….Whereas the 5-year sexual recidivism rate for high-risk sex offenders was 22% from the time of release, this rate decreased to 4.2% for the offenders in the same static risk category who remained offence-free in the community for 10 years.”

Most recently, Rachel Kahn, Gina Ambroziak, Karl Hanson, and David Thornton examined 5-year re-offence rates, and – focusing on the lowest risk adults who had sexually abused -- they found that, “Within this lowest risk category, recidivism rates are equivalent to rates of spontaneous offending among non-offender populations… Adjusted to a common 5-year period, estimated recidivism rates ranged from 0.22 to 5.67% with a median rate of 0.90%. The lowest recidivism rates were observed for the studies that used incarceration as the outcome criteria.” Kahn and her colleagues also asked, “If we are to take the Risk Principle seriously, what level of sexual offender-specific treatment should be provided to individuals whose risk is so low that 98 out of 100 would not re-offend if we did nothing?”

Why is this so important? To start, many professionals working with people who have abused have worked under the assumption that people who abuse are unable or unwilling to change. Ideas such as “there is no cure for sex offending” were so pervasive as to be written into statute. Indeed, many laws and the findings of the US Supreme Court have been based on the faulty belief that re-offence rates are “frightening and high”. Despite international news coverage dispelling this misconception, little has changed. It is vital that evaluators and therapists alike are aware of the importance of time free in the community.

Taking together the findings from elsewhere in the literature, it seems that the most effective means for preventing sexual re-offence lie in active approaches, such as treatment and supervision based in principles of risk, need, and responsivity. Currently, our communities all too often rely on more passive approaches that restrict liberties, such as public registration, notification, and residency restrictions, but these approaches do not reduce risk.

Until our communities and policymakers recognize that the same “rules” and evidence are found across people who offend (and that people who offend sexually are not unique) based on studies now involving hundreds of thousands of criminal offenders, we will continue to funnel resources into policies found to be largely ineffective. Given that knowledge about what works to prevent crime is readily available to these policymakers, it is unconscionable that there has been little, if any, move towards empirically informed policy within our legislatures.

Just last week, we blogged about international perspectives on the management of people convicted of sex crimes and noted the number of countries that appear to follow the United States’ lead. It’s time to stop this trend and up our game with respect to informing the public about the many ways we can prevent abuse meaningfully.

As co-blogger Kieran McCartan observed in the preface, “This special edition started as an international roundtable at the Annual ATSA (Association for the Treatment of Sexual Abusers) conference in Kansas City in 2017, which was organised by the ATSA international committee, which had representatives from 9 countries (UK, Belgium, USA, Canada, Netherlands, New Zealand, Sweden, Italy, & Germany).” Contributors to this roundtable were asked to submit 4,000 words, with additional commentary provided by ATSA President Franca Cortoni and IATSO Secretary General Martin Rettenberger.

This double issue is too extensive to cover in detail but contains fascinating updates from around the world. Danielle Harris and Samara McPhedran open with an overview of trends in Australia, which include similar trends towards more punitive responses to those in the USA. For example, although there is a registry of persons convicted of sexual crimes, it is not publicly accessible. There are some (concerned parents, lawmakers, and a very vocal news commentator) who are pushing to change this and expand the reach and accessibility of the registry.

Meanwhile, in Belgium, Kasia Uzieblo and her colleagues contribute with a discussion on the need for consistent approaches to risk assessment, particularly in the wake of a high-profile, tragic case. As elsewhere, the public’s moral outrage is a challenging backdrop against which to build science-based policies and approaches. In Canada, Mark Olver and L. Maaike Helmus describe the implementation of risk assessment measures, including recent controversies regarding the use of this instrumentation with people of aboriginal descent. In contrast to these countries, Anita Schlank describes the differences between many of the individual states within the US, including differences in sentencing and residence restrictions. Other contributions include those by Carla Xella in Italy, Anette Birgersson in Sweden, Ting Ming Hwa and colleagues in Singapore, Wineke Smid in the Netherlands, and many others.

Understanding what is happening in other corners of the world can produce considerable dividends in understanding how our individual jurisdictions can be better. Further, learning about innovations elsewhere can be enormously helpful in our attempts to end sexual violence.

Monday, December 3, 2018

During the past week, we were invited to provide a four-day training on the Good Lives Model (GLM) to the Society of Rehabilitation and Crime Prevention (SRACP) in Hong Kong. As many readers will be aware, the GLM has come into widespread use around the world. Originally designed with a focus on people who have sexually abused, the GLM can be (and has been) modified for use with people who have committed a number of harmful behaviors. Indeed, the SRACP works alongside people returning from prison for any type of offending.

In essence, the GLM holds that all human beings seek out certain experiences, goals, and states of being (Prescott, Willis, & Yates, 2015; Willis, Prescott, & Yates, 2013; Ward & Maruna, 2007). For example, virtually everyone wants to be good at something in his or her life. The GLM further holds that in many instances, these good life goals play a central role in problem behavior. For example, one’s drive towards independence and autonomy can contribute to harmful behaviors that are as diverse as partner violence and substance abuse. The same goes for good life goals such as being connected to others, finding peace of mind, and experiencing happiness and pleasure. Ultimately, the GLM separates itself from other forms of treatment for problem behaviors through its twin focus on building competencies as well as managing risks. It does this with an explicit focus on “approach goals”: those goals we set for ourselves that we can approach instead of simply avoiding.

Applying any model across cultures brings inherent challenges. Fortunately, SRACP had experience in this area. They have been active for many years in selecting empirically grounded methods and approaches that could be useful within their specific context. In recent years, they had worked to import methods for adhering to the principles of risk, need, and responsivity. As a group, the professionals involved (primarily from social work backgrounds) had studied in additional areas of psychotherapy, such as Eugene Gendlin’s Focusing.

The broadest discussion of cultural differences in the application of the GLM was in the area of two of the GLM’s overarching common life goals: Personal choice/independence (i.e. having a measure of independence and autonomy in one’s life) and relatedness (i.e. being connected to others). In the context of Asian societies with collectivistic orientations, differentiating these goals can be a challenge. For example, the simple question, “How are you doing” brings a different meaning in the Far East than it would in the western world. “How are you doing” implicitly means, “How are you doing, including in the context of your family and other loved ones?” When clarifying the elements of an individual’s desired future lifestyle, separating these components out for discussion can be a novel experience. Similarly, the GLM’s focus on an individual’s conception of a good life and their good life plan was integrally linked to that of their families. Nevertheless, personal choice/independence was implicated in many of the case examples of crime that came up during the four days. The individuals that SRACP treats have often behaved in ways that bring them into conflict with their overarching goal of being connected to others (for example, by committing crimes that bring dishonor to them). Although finding the right balance of independence and connection to others can be difficult for anyone in the world, it provides particularly rich opportunities for clinical discussion in China.

SRACP has also grounded its implementation efforts in research. Implementation science has shown that these efforts can take very considerable time and effort. It is never as simple as bringing in outside experts and providing training. A major focus for us has been in building on the experience of others to find implementation strategies that involve and are meaningful to those working at the front lines. To this end, consultation and the development of materials for assessing progress in the SRACP’s specific context are ongoing.

Monday, November 26, 2018

Last week Latvia, in conjunction with the EU, the Confederation of European Probation, hosted two conferences on the management of people who have committed sexual abuse. This blog is going to discuss both conferences and the lessons learnt from them.

Multi-agency Co-operation: Sexual Offending (21st November 2018)

This conference was organised and ran by the Latvian criminal justice organisations (i.e., Police, Probation & Prisons) in co-junction with related NGO’s (i.e., Center Dardedze) to discuss multi-agency co-operation in working with people who committed sexual offences, and their management, in Latvia. The main theme of the conference was co-operation and sharing best practice, which was facilitated through a series of keynotes and workshops covering a range of topics, including, (1) European perspective on work with sexual offenders (Willem van der Brugge), (2) The prevention of sexual abuse (Kieran McCartan); (3) Challenges and solutions relating to effective multiagency working (Mike Cutland; Jānis Zārdiņš, Valdis Groza & Iveta Štrausa; Māris Luste); (4) The aetiology and treatment of people who commit sexual abuse (Audrey Alards; Sanita Jakuševa & Evija Burkovska); (5) Victims of sexual abuse (Imants Jurevičius & Laila Balode; Laila Balode &Laura Ceļmale); (6) Pornography and Child Sexual Exploitation Material (Andris Šillers &Iveta Ķelle); & (7) Circles of Support and Accountability in Latvia (Jānis Nicmanis & Kristiāna Lapiņa). From the start of the conference it was apparent that all the lead organisations where on the same page when it came to understanding and responding to sexual abuse, everyone wanted the same thing – a victim oriented, evidence informed, collaborative approach to sexual abuse which was grounded and realistic. It made me reflect that we, those of us from countries with a more established approach to the management of people who committed sexual abuse, could learn a lot about the power of interagency co-operation from our Latvian colleagues. During the course of the conference, and the conversations that followed, it really stuck me that Latvia had really benefitted from collaboration with other European, as well as American and Canadian, colleagues over the past 3 years in upskilling their knowledge and practice in the area of sexual abuse. Latvia is now on a par, or close to being on a par, with other countries in terms of existing knowledge and in terms or emerging challenges as well as how to start to respond to them (i.e., online offending, the use of restorative justice, cross border issues, etc).

Reframing sexual abuse conference (22nd – 23rd November 2018)

The reframing sexual abuse conference was the 1st conference to be held by the Confederation of European Probation “Expert Group on Sexual Offenders”. The conference had 120+ attendees from 19 countries from across Europe (incl., Spain, Germany, Netherlands , Norway, Denmark, Lithuania, Ukraine, Sweden, Jersey, UK, Belgium, Italy, Latvia) and outside of Europe (i.e., Japan, South Korea, Malta). The aim of the conference was to understand good practice in the field of sexual abuse from across Europe and to learn from each other’s good practices. The conference had 14 speakers from across 8 countries and covered topics, including (1) Circles of Support and Accountability (Mechtild Höing; Circles Europe); (2) the framing of sexual abuse (Kieran McCartan), (3) the challenges of integrating people who have sexually offended back into the community (Mike Cutland & David Briggs); (4) the risk assessment and management of people who have committed sexual abuse (Anvars Zavackis. Wineke Smid, Carla Xella, Laura Kuhle & Kasia Uzieblo; Marianne Fuglestved); (5) Online sexual abuse and Child Sexual Exploitation Material (Virginia Soldino & Maggie Brennan); & (6) the development of the Latvian approach to the management of people who have committed sexual abuse (Mr. Imants Jurevicius and Mr. Anvars Zavackis). At the start of the conference Audrey Alards (the chair of the Expert group) revealed the results of a CEP study on the experiences and practices of the management of people who have committed sexual abuse across Europe, it highlighted that there are still inconsistent practices with different countries do different things, resulting in a discussion around the need for a common framework. The conference really wanted to explore the outcomes of the expert working group data and held a roundtable with the four keynote speakers (Imants Jurevicius, Wineke Smid, Marianne Fuglestved & Mechtild Höing) which focused on their thoughts, attitudes and experiences on issues including community engagement, treatment, management, policy and practice. The roundtable emphasised the importance of collaboration, research, evidence based practice and ongoing communication. In addition to the presentations, the conference saw the formal launch of Circles Europe, which highlighted the challenges, practices and opportunities for public engagement in the integration of people who have committed sexual abuse back into the community. The Circles Europe launch demonstrated the power of adapting international good practice in countries specific ways that made communities safer from sexual abuse and sexual recidivism. The conference emphasised the importance of communication and collaboration, in the end the most important outcome was the fact that we as a community of researchers, practitioners and policy makers have to work together so that we can effectively prevent sexual abuse locally, nationally an internationally.

Monday, November 19, 2018

A recent high-profile rape case in
Ireland
has reinforced the ubiquity of rape myths in the legal system. During the trial,
the barrister for the defence encouraged the jury to consider the nature of the
victim’s underwear, a thong, on the night in question. The clear indication was
that the nature of the victim’s underwear showed that she was “consenting” and
that she knew what was going to happen. This approach, in conjunction with the
rest of the evidence and arguments, resulted in dismissal of the case with a verdict
of no rape. The fact that it was a jury trial suggests that the case reflects
beliefs held across society. The trial reinforces that rape myths are alive and
well in 2018, not only in Ireland but internationally.

Rape myths are attitudes and beliefs
that reinforce sexual assault as acceptable and shift the blame away from the
person who perpetrates sexual violence onto the person who is victimized. (See Cambridge Rape Crisis
centre for a breakdown for these rape myths.) Often by shifting
responsibility into the complexity of sexual relations, these myths reinforce
actions that perpetuate victim blaming. The collateral consequences of rape
myths are significant and normalise social attitudes around sexual abuse and
toxic masculinity. These same beliefs defy logic; looking attractive is not the
same thing as wanting to be violated. It’s like saying that the ducks wanted
the hunter to shoot them or they wouldn’t have been flying so close to a lake,
or that someone deserves to have their data stolen because their network lacks
adequate protection against hacking. There is no evidence suggesting that
wearing particular clothes increases risk for assault; those who work in the
field know that there is no definitive profile of either victim or abuser.

Research indicates that rape
myths are still prevalent in society (Breines,
2012) as well as in the legal system (Smith & Skinner, 2017; Temkin,
Grey & Barrett, 2016). This acquiescence to rape myths is worrisome given
their persistence despite being challenged in recent years internationally,
including through the #MeToo movement and the
recent exhibition of rape victims clothing in Belgium. Each instance has
shown that rape myths are ingrained in our social norms and beliefs. Changing
social norms and beliefs are difficult in the best of times, but this change
becomes harder when it focuses on topics like sexual violence and harassment—topics
that we, as a society, are not always willing to discuss in education or in
communities more broadly.

We need to reconsider how best to
(re)educate communities and individuals about rape myths and how we can all push
back against victim blaming. As we and many others have noted, here and
elsewhere, our communities will benefit from improved bystander training and
community engagement. This involves shifting our focus from a criminal-justice
approach to a public health approach towards sexual abuse. This is particularly
important given the recent rise in the reporting, recording and sentencing of
sexual abuse cases in the UK over the last 5–10 years as a result of increased
trust in the system and a belief that their case will be taken seriously.
Unfortunately, the persistence of rape myths and victim blaming undermines the
victim journey and damages trust in the system.

The response to the Irish trial
has been varied, indicating that people are pushing back on rape myths,
including MPs
speaking out in the Irish parliament, protests
in Belfast, as well as online condemnation
via the hashtags #IBelieveHer and #ThisIsNotConsent. Our challenge is how we
change the social complaisance toward rape myths so that juries have a
realistic understanding of them and can make better informed decisions, and
that the system —particularly judges—can challenge inappropriate outcomes.

A final point that too often goes
undiscussed in media accounts is that those who perpetrate abuse and society at
large aren’t the only ones internalizing these myths. All too often, in our
experience, people who survive sexual assault come to believe that they didn’t
deserve better. And, of course, everyone deserves to be free from abuse.

Friday, November 9, 2018

The theme of ATSA’s 37th Annual Conference, “Better Together” felt desperately needed against blatant hate speech, and acts of racial bias that has become more prevalent, and supported, in our neighborhoods, as well as in our social media, news media, civil discourse, and politics. I had all this in mind as I listened to Elder Gerald Oleman, one of the 2018 ATSA Conference keynotes. He drew from his personal experience and Indigenous history to address why racism is so important to understand, especially in our work that is so linked to treating trauma. Elder Oleman pointed out that Europeans have a different culture and explained, “when it hit ours, it was a tsunami that flattened us, and we are still trying to stand back up.” He described colonization as “complete political and economic control over indigenous people and their land”. He gave several examples of how this shows up with so many “images of indigenous people as less than.”

In May of 2017, the ATSA Prevention Committee started to discuss various ways that addressing privilege and race fit with strategies to prevent sexual violence. The discussions included the research showing that entitlement and dominance are core contributors both to sexually aggressive behavior (e.g., Knight & Guay, 2018; Malamuth, 2003) and to the maintenance of privilege and the continuance of racial prejudice. Given the conversations in the public domain, ATSA has a unique voice to contribute to this conversation. We also discussed that we may not be fully addressing this issue within our own work and that ATSA should be concerned with considering privilege and race not only as they impact the exacerbation of sexual harassment and sexually coercive behavior, but also as they affect ATSA’s therapeutic and prevention focus. (adapted wording from ATSA Executive Survey Summary, 2018).

At the October 2017 ATSA Conference, the Prevention Committee sponsored a well-received panel to discuss these issues. During this past year, as a follow-up to this discussion, the Committee developed a survey to learn how ATSA members view these issues and their interest in ATSA taking further action. With 375 ATSA members responding, this is what we learned:

Ø87% of survey respondents endorsed either “agree” or “strongly agree” to statements indicating that race and privilege had an impact on perpetration, survivors’ healing process, and prevention of sexual violence.

ØSurprisingly, respondents suggested that race and privilege had less of an impact on various areas of their own work (i.e., an average of 76%). This merits follow-up to determine if it reflects resistance to addressing this issue in their own work.

ØThe majority of survey respondents affirmed the overall need for ATSA to address issues related to race and privilege (76%).

Based on the outcomes of the survey, the Prevention Committee made recommendations to the ATSA Board to explore ways that ATSA as an organization and in our membership can address issues of race and privilege in our work. Alison Hall, co-chair prevention committee and ATSA Board of Directors member, reported that ATSA’s Board of Directors has formally “recognized that race and privilege impact ATSA’s work, and the work of ATSA members. Furthermore, the board voted to ensure that ATSA commits to incorporate privilege and race issues into all its strategic goals.” Each of ATSA’s committees will be looking at how race and privilege affect their work. The Prevention Committee is further exploring member responses through a series of interviews that were conducted during the recent ATSA Conference. We hope to be able to provide some of the resources that were requested during these interviews and through the surveys.

The interest and ATSA’s Board of Director’s response are essential to shine a light on the intersection between entitlement, privilege and racism and the work needed to prevent sexual violence. Going back to Elder Oleman’s keynote, he explained that “People that lose their way start to harm people.” He asked the audience “What can we do for the children to prevent this from happening?” Part of what we can do is to continue to understand the privileges we each have and how they can be used in constructive rather than destructive ways. Prevention involves working to overcome the “othering” that allows people to be treated as objects or commodities that are less than. As we struggle to not be hooked by our fears, but instead to understand to build on our connections between prevention, research, policy, and treatment, between the voices of those harmed and those who created the harm and across races, cultures, genders, and sexual identities religions. We can bring depth and action to the conference theme; we are indeed “better together:”

Tuesday, November 6, 2018

We have recently had some changes here
at the Sexual Abuse Blog with Alissa Ackerman deciding to step back from active
blogging. David and I would like to take this opportunity to thank Alissa for
all her hard work on the blog over the last year. Alissa's blogs have always
been insightful, critical and pertinent; she has brought a victim focus to the
blog and insightful edge through her contributions. We wish her luck for the
future and will always positively receive any future blogs that
she would like to submit. So farewell, rather than goodbye!

Friday, November 2, 2018

This post picks up where the last one left off. The context is that a participant in a training recently described frustration with implementing Motivational Interviewing in their practice. This echoed a concern I’d seen expressed in social media. As the discussion progressed, another participant expressed similar experiences. Although small in number, their concerns were important: There can be side effects when adjusting to the use of positive, collaborative, strengths-based approaches such as Motivational Interviewing (MI) and the Good Lives Model (GLM). How can this be? What can we do?

Beyond the considerations mentioned earlier (context, status of working alliance, etc.), a factor that has often gone under-appreciated until recently is the effect of early trauma and other adverse experiences. From the outset, clearly trauma and adversity can be difficult concepts to work with. What is traumatic to one person may not be traumatic to the next, while many people (including professionals in our field) appear to develop extreme strength and resilience in the aftermath of abuse.

Further, what can appear as traumatic to the person who experiences it may not be in the eyes of others. This becomes especially difficult to understand when the experience(s) took place at an early age, when the client had not yet developed the necessary language skills to describe his or her experiences. As one person once stated it, “From the outside looking in, it’s hard to understand, and from the inside looking out it’s hard to describe.”

Finally, in some cases, the uncertainties involved in sexual development can combine with mental health conditions to create unusual situations. For example, one ATSA pre-conference workshop several years ago focused on a person on the Autism spectrum who had somehow been deeply affected by watching cartoons while masturbating, with the end result being a very rare form of sexual disorder in early adulthood. Although a statistical outlier, a deep understanding of how the events in his life had affected his development was critical to understanding him and providing treatment.

Any of these scenarios can combine to make clients appear challenging, unmotivated, or written off with such language as, “He just doesn’t get it.” Consider the following statement from a person in a community-based residential program. He has a history of trauma who was found not quite competent to stand trial. When asked to describe a seemingly innocuous event from the preceding week, he says: “I can’t… Ummm…. It doesn’t matter… Look, never mind.” Imagine that this has actually been similar to past responses to questions about his current status; discussing his past behaviors has been virtually impossible, and when it occurs ends in his experiencing shame and hopelessness.

In this client’s case it can be easy to assume that he is unwilling to participate meaningfully in treatment despite his statements that he wants to do what he needs to complete the program and return to the community. It’s easy to think that his statement translates directly into “I don’t want to talk with you, and I am not going to let you know that. Instead, I’m going to feign being upset.” While this translation may be partially true, it likely isn’t the entire story in this case. This pattern of responding might also translate as, “The only reason I’ve survived my life up to this point is because I am constantly evaluating my environment for evidence of threats. Now you are asking me to look inside my own experience, and I’ve never developed meaningful skills for that. Also, my words have been used against me much of my life, and I don’t understand how you can expect me to trust you so quickly. On top of that, I’ve never developed the kind of language skills to express to you how hard it is for me to view the world as anything but a dangerous place. You want me to talk. I can’t do that safely right now. The only option I can see is to shut down. If you keep pushing, I may need to become violent.

Ultimately, the move to trauma-informed care is not about helping people feel as though they are passive victims of a cruel world. It’s about understanding how events shape people at the individual level, one client at a time, and designing interventions that they can respond to, in adherence to the responsivity principle of effective corrections.

Friday, October 26, 2018

The annual ATSA
conference took place from the 17th – 20th October in Vancouver.
The conference was a real mix of research, practice and engagement with
international colleagues from 16 different countries including the USA, Canada,
UK,Australia, New Zealand, Sweden,
Germany, Hong Kong, Netherlands, Belgium and Israel to name a few. In this blog
we are going to take you on a whistle stop tour of the event.

For Kieran, the highlight of the conference
was Ruth Mann’s opening plenary in which she discussed the challenges of developing
an evidence base. Ruth’s presentation focused on what the risk, consequences and
impact of being evidence based are in the real world, and more specifically in
a public arena; especially if the evidence base negates your current working
practices. Ruth discussed the recent changes to sex offender treatment in the
UK and the government evaluation which initiated these changes (i.e., it
indicated that previous programs had no impact or made people slightly worse,
rather than better); reflecting upon the personal, political and policy fallouts.
Ruth discussed the content of the report, her reflections of the impact of the
report on systems as well as institutions, and report’s consequences for the
management/treatment of people who have committed sexual abuse. In closing, she reminded us that if we are to
be truly evidenced based we have to be open to all forms and outcomes of
evidence, even the evidence that indicates that what we are doing may not be
best practice or achieving what we want it to achieve. To Kieran, this set the
tone of the conference as ATSA has always been about sharing good practice and
reflecting upon problematic practice.

The engagement
event at the 2018 ATSA conference was based around bystander intervention and
had colleagues from Simon Frasier University (Ashley Bentley) and community
action groups (Katheren Szabo) talking about the work that they were doing to prevent
sexual abuse. The fact that the speakers were coming from different parts of
the community, used different approaches and engaged in different activities (from
campus sit in’s, to poetry readings and gardening clubs) really indicated the
range of activities and novel ways that we can engage different “communities”
around sexual abuse prevention in ways that are meaningful to them. The
engagement event this year was targeted at people involved in professions at
the frontline of safeguarding and community participant (i.e., teachers, volunteers,
community workers, etc) and this resulted in some interesting and practical
debates.

The
international roundtable this year had a series of 8 minute talks from 9
different speakers, each from a different country, on public/media attitudes to
sexual abuse in their country and how professionals are engaging in the debate.
This was interesting as there were a lot of common themes across countries
(i.e., “not in my backyard”, negative media stories and good/bad examples of
professional and policy maker engagement) as well as some distinctive good
practices in certain countries that we could all learn from internationally.
The roundtable really cements ATSA as an international conference!

The entire
conference was a high point of the year for David. Although pinpointing specific moments is next to impossible,
three come immediately to mind:

First, I had the
privilege of moderating a symposium with Tony Ward, Gwen Willis, and Roxie
Heffernan. Tony and Roxie discussed many of their recent projects which involve
looking at the processes underlying risk and protective factors. A down side to
having so much research available to us regarding these factors is the
temptation to reify them as discrete factors rather than viewing them as
proxies for underlying processes which will be different for each person.
Although on its own this is not a new idea, Ward and Heffernan have explored
this in very great detail in their risk-causality method. For Tony and Roxie,
this method provides a new level of explanatory depth to our knowledge of risk
and protective factors. For Gwen and David, it provides rich areas of clinical
understanding.

Second, Laurie
Rose Kepros delivered a fascinating workshop describing the effects of
experiences within the legal system on people convicted of sex crimes. Titled the process is the punishment, she
explored how elements of these experiences can actually have a detrimental
effect on engagement in rehabilitation efforts (e.g., engagement in treatment
and with supervising agents). This is clearly a situation involving multiple
perspectives. On one hand, the US Supreme Court has been clear that law
enforcement officials can use deception as a part of the investigative process.
On the other hand, this same deception can be devastating to others’ attempts
to engage meaningfully with these people after their conviction, particularly
when they view professionals as agents of the police power of the state. As one
might imagine, the subsequent discussion was lively, with advocates of each
perspective describing points for consideration.

Finally, Michael
Seto delivered a moving speech as he accepted this year’s Lifetime Significant
Achievement award. With his father and brother on stage, he described the
important contributions of immigrants to the cultures who receive them.
Originally from Hong Kong, Seto is a clear example of why this is so.

For Alissa, the Vancouver ATSA conference
was among the best she has ever attended.

Along with Joan
Tabachnick and Cordelia Anderson, Alissa co-led a pre-conference seminar titled Accountability and Responsibility in the
Era of #MeToo. We quickly learned that this is an important issue that many
clinicians are currently grappling with. The presenters lead participants in
pseudo-restorative justice circles, which provided opportunities to experience
the power of authentic human connection. By embracing and honoring a common
humanity, clinicians and restorative justice practitioners can create safe
spaces for those who have sexually violated others and those who have
experienced sexual abuse to find common ground and healing.

Perhaps the best
example of this was articulated by our Friday morning plenary speaker, Gerry
Oleman, a First Nations man who has been involved in creating change for First
Nations communities since the 1970s. Gerry spoke about the importance of
connecting to language, to nature, and to each other. He spoke about the
atrocities committed by colonizers, including the rape of First Nations people,
the forced enrollment of indigenous children in residential schools, and the
violent removal of indigenous people from their land onto reservations. Gerry
spoke about the importance of healing, not allowing the pain, anger, and
violence, stay on his heart. It was a lesson that everyone in attendance was
privileged to hear.

One of the
primary benefits of being an ATSA member and attending the annual conference is
the opportunity to connect with friends, colleagues, and collaborators from
around the world. This was true for Kieran, David, and Alissa who had the
chance to present on a panel with Danielle Harris, Jill Levenson, and Gwenda Willis.
On Friday afternoon, we presented a panel titled Are We Listening: Valuing All Individuals Impacted by Sexual
Victimization.

We were each
given ten minutes to present on one of the specific voices impacted by sexual
victimization. None of us knew what to expect with this unique format, but the
feedback we received from audience members reminded each of us about the
passion inherent in our individual work that we then bring to the table when we
work as a team. After all, we are all better together.

The primary take-away from these conference
experiences for all three of us was the importance of working together towards
common goals… “Better Together”, the conference theme, appropriately described
it. In the end, we are all at our best when we can discuss the issues of the
day, acknowledge differences, come together to establish new ideas and goals,
and make them happen; next year it’s Atlanta, Georgia!!

Wednesday, October 10, 2018

On September 28, 2018, HBO’s Vice News Tonight aired a special on consent and accountability. The episode ended with a restorative justice (RJ) session that I facilitated. For the first time, a mainstream media outlet highlighted the power and depth of RJ in cases of sexual misconduct.

I have written elsewhere about the importance of RJ. During the heightened conversations around accountability in response to the Brock Turner case, Dr Jill Levenson and I co-authored several blogs on what a different conversation might look like, even appearing as guest bloggers for the Sexual Abuse blog. We have written about the importance of a change in discourse, where we no longer see those who have perpetrated sexual abuse and those who have experienced it as diametrically opposed and we have discussed the importance of actual accountability, a process that the criminal justice process seriously thwarts. Yet, in the years of engaging this work, I have not experienced the promise of a moment of reckoning such as this one.

The conversation around RJ and sexual misconduct is not new, but it has not been mainstream either. The Vice News episode on consent and accountability created an opportunity to shift popular discourse. Prior to this episode, few had even heard of the term restorative justice. One television anchor repeatedly referred to the process as reformative justice. Despite the lack of collective knowledge or understanding of what RJ promises, the responses I have received since the HBO episode aired almost two weeks ago have been both heart wrenching and full of hope.

I have heard from those who have experienced sexual abuse who want nothing more than to find closure and hope for the opportunity to sit face to face with the person who harmed them. I have heard from people – both those in my life and complete strangers – that the Vice News episode expanded their thinking about the ways they have behaved in the past. I have also heard from those who are now remembering experiences that were harmful.

For too long we have allowed our conversations around sexual abuse and misconduct to remain siloed. This includes many of us in the fields of sexual abuse treatment and prevention. There are professionals who advocate for those who have been sexually victimized and those who work with individuals who have sexually violated others. Even when we recognize that many of our clients fit both boxes, we tend to talk about “survivors” and “perpetrators” as mutually exclusive groups.

The fact of the matter is that all of us focus on the same end goals – healing and prevention.

The Vice News special featured two RJ participants, Alexis and James. I have been working closely with Alexis and James since January. Their progress, both as individuals and collectively, has been nothing short of amazing. Both articulate how the process has helped them rediscover each other’s humanity. Alexis has seen a marked decrease in the PTSD symptoms she had lived with for the previous ten years. More healing has occurred in the last nine months than in the previous ten years, simply because the two were willing to connect in a vulnerable and authentic way.

Criminal justice processes can include RJ. In fact, most of the RJ work in which I have engaged has been with men and woman mandated to treatment after a sex offence conviction. The most life-changing and life-affirming moments have arisen from these RJ processes, but they leave me wondering what impact RJ could have at the beginning of the criminal justice process. How much harm, pain, and shame could be avoided if we engaged? How many people would take accountability for their actions, or at the very least consider the harm their behaviour may have caused if there were spaces for them to do so?

When I first began speaking about RJ and sex crimes, the very idea offended many people. Today, those same people have inquired about how they can be involved. The HBO Vice News episode finally shined a light on a process that can help heal individuals, communities, and perhaps our entire society. One cannot disentangle the timing of this episode and our current political climate. Indeed, Lara Bazelon published a piece in Slate about how we are in dire need of RJ in the wake of this most recent Supreme Court confirmation. We remain fully entrenched in an adversarial model that has proven repeatedly that it does not work. Perhaps when we move away from such a model, healing can finally begin.

We are professionals in the field of prevention and treatment and we must be the first to step out of our silos.

Wednesday, October 3, 2018

A participant in a training recently described frustration in adopting Motivational Interviewing in their practice. This confirmed a concern I’d seen expressed in social media. As the discussion progressed, another participant expressed similar experiences. Although small in number, their concerns were important: There can be side effects when adjusting to the use of positive, collaborative, strengths-based approaches such as Motivational Interviewing (MI) and the Good Lives Model (GLM). How can this be? What can we do?

First, it’s important to examine the context. In many instances, the complaint centres on probation officers and other supervising agents who come away from trainings believing that they now need to behave like therapists. Others have complained that they have to pay attention to how they respond and use reflective listening rather than focus on efforts at rehabilitation. Still, others feel cornered into working in a fashion that is at odds with their personal style. One person lamented that clients are challenging their treatment before they even get started. The result, in the estimation of these professionals, is that clients can appear more hostile, often with a sense of entitlement. Where public safety and client care are on the line, these are important concerns.

What do we know? First, the jury has returned on many of the characteristics of effective treatment for people who have abused. Marshall (2005) summarized findings showing that the most effective therapists are those who are warm, empathic, rewarding, and directive. In practice, any one or two of those qualities can be easy, but balancing all four can be a challenge. Three years later, Parhar and her colleagues demonstrated in a meta-analysis that the more coercive the treatment experience for mandated clients, the less effective they are. There’s really no question that the often harsh and confrontational practices of yesteryear don’t work and can make matters worse. It is no wonder that Moyers and Miller (2013) argued that low levels of demonstrated empathy are toxic. Since that time, the use of MI (and its derivatives) with criminal justice populations has only become more widespread. Earlier this year, Blasko and Taxman (2018) found that clients who perceived their probation officer as fair and respectful had lower rates of violating their conditions and returned to prison less frequently.

Does that really mean that effective practices create more problematic clients? I don’t believe so, although it’s an important question. Here’s what I mean:

First, clients feeling free to challenge their treatment and treatment providers at the outset may actually be preferable in the long run to clients who give the surface impression that they are actively engaged but in fact participating minimally. As the old adage goes, “A man convinced against his will is of the same opinion still.” Although every case is different, there may even be real merit in challenging one’s circumstances prior to making peace with them and getting involved in meaningful change processes. This idea is central to self-determination theory, which holds that extrinsic motivation often precedes intrinsic motivation. In the long run, pushing back against extrinsic motivators as a pathway to awakening internal motivation can have real value in treatment.

Further, there are contextual challenges with our training approaches. All too often, trainees are “voluntold” to attend trainings and adopt the new practices (that strange experience of being volunteered by a supervisor to participate against one’s will). Not surprisingly, there is a strong parallel process between the practitioner who is ambivalent about adopting new treatment methods and the client who is ambivalent about change. As much as agencies focus on what they believe are best practices, it is easy to forget the importance of the change process for the professional. Further, the fact that some agencies prefer some evidence-based approaches over others speaks to the fact that we are often not as evidence-informed as we would like to think.

Then, there are other problems with implementing new approaches. Often overlooked, an entire body of research has examined how treatment implementation efforts succeed and fail. Bringing in the expert from out of the area to do training is easy; implementing with fidelity and minimal attrition and client drop-out is another matter entirely. Often, this can occur when professionals only learn the basics and are expected to jump into practice. For example, many MI trainees wonder how they will carry out parts of their job (sometimes known as “telling the hard truth”) without having learned the explicit methods for doing so (for example, the elicit-provide-elicit method of providing information and feedback).

Finally, all of these efforts rest on the foundation of a strong working alliance. The alliance is often mistaken for having a good relationship with a client, but in fact has been defined for decades as having an agreement on the goals and tasks of treatment, as well as agreement on the nature of the working relationship. More recent conceptualizations consider the strong personal values and beliefs of the client. In my experience, many programs who seek enthusiastically to develop expertise in a specific model or set of techniques can also be those that rate themselves as doing well enough with their alliances that this needn’t be an ongoing area of focus for them. This is despite the fact that simply ensuring a solid alliance is itself a highly evidence-informed practice.

In the end, when clients become challenging despite the available collaborative approaches, it may be as simple as returning to basic discussions about what the client wants out of the experience in order to establish goals. After that, the practitioner can work on gaining clarity on the exact nature of who the practitioner and client are so that they can agree on the nature of the relationship. Next, the practitioner may want to ensure that his or her approach is a good fit for the client, and consider a person’s unique characteristics, culture, values, and beliefs.

All too often, the problems lie not in the methods or models, but in the ways, we attempt to implement them. This can be especially problematic when we attempt to use newer methods without first ensuring a solid working alliance.

Wednesday, September 26, 2018

The annual NOTA conference took place from the 19th – 21st
September in Glasgow. The conference was a real mix of research, practice and
engagement with colleagues from across the UK, Ireland and internationally
(with attendees and speakers from a range of countries including the USA,
Australia, Norway, Ireland, and from all four countries of the UK). In this
blog I am going to take you on a whistle stop tour of the event.

The 2018 plenaries combined research, practice and innovate approaches
from a very international group of speakers. The conference started on the
Wednesday with two keynotes addressing the reality and impact of Pornography on
youth understandings and perceptions of sex as well as their sexual experiences
(Maree Crabbe) followed by an
overview of the research on systematic pathways of development across the
lifespan, ACE’s and the impact of trauma (Dr
Jamie Yoder). The second day of conference (Thursday) had keynotes that
talked to current research and understandings around normal sexuality, deviant
sexuality and whereof our morality and ethical principles come into play in
debate as well as treatment (Dr Rajan
Darjee); as well as presentation of focusing on trauma inform care and
practice on the frontlines in Scotland (Dr
Lisa Reynolds). The last day of the conference (Friday) had 4 keynotes, the
first two focused on arange of topics
including, the effectiveness of professionals perspectives terminology,
learning and good practice around Child Sexual Exploitation (Jessica Eaton); and an update on
desistence research and the importance of community engagement and the “service
user” voice in the integration of people who have committed sexual offences
into the community in a pro-social way (Dr
Beth Weaver). The last two keynotes of the conference focused on sexual
abuse in Scottish Football, discussing the work of the review and the interim
report into the scale and nature of said abuse (Martin Henry); and finally, a presentation on the reality, impact
and scale of sexual abuse with private schools over the past 30 (or so) years
(Alex Renton). All the keynotes tied together ideas of the importance of
Adverse Childhood Experiences in the lives of people who sexually offend, the
roll of trauma in shaping their behavior and that prevention is needed, but
more centrally that prevention is everyone’s responsibility.

In addition to the traditional conference activities NOTA 2018 also
had an engagement event. This year we changed our focus from members of the public
to professionals. We advertised the engagement event to professionals who have safeguarding
as part of their jobs, but that safeguarding is not their main role (and
therefore would not be attending the NOTA conference) including, teachers,
foster carers, members of charities and NGO’s, etc. We had 150 participants sign
up to attend the event but, unfortunately, bad weather in Glasgow lead to the
closing of Glasgow Central Train Station which resulted in approximately 50 - 55
people attending; which, in the circumstances, was a good outcome.The session heard from national (Stuart
Allardyce, Graham Goulden & Kieran McCartan) and international (Maree
Crabbe) speakers about the impact of pornography on youth, especially young men;
what we can do to reduce toxic masculinity and the “crisis” surrounding young
men; and how to promote positive, healthily sexuality.

NOTA 2018 also was covered by the Scottish Herald, which had a
two-page piece in the main edition and this was republished on their website as
well. The herald piece focused on the prevention of sexual abuse, including
interviews with Stuart Allardyce, Marre Crabbe, Graham Golden, Lisa Reynolds
and myself. For those interested please access it here.

NOTA 2018 fitted a massive amount of material in across three days,
which left me informed, refreshed and looking forward to next year’s meeting in
Belfast.

Kieran McCartan, PhD

Chief Blogger

David Prescott, LICSW

Associate blogger

Translate

The Association for the Treatment of Sexual Abusers (http://atsa.com/) is an international, multi-disciplinary organization dedicated to preventing sexual abuse. Through research, education, and shared learning ATSA promotes evidence based practice, public policy and community strategies that lead to the effective assessment, treatment and management of individuals who have sexually abused or are risk to abuse.

The views expressed on this blog are of the bloggers and are not necessarily those of the Association for the Treatment of Sexual Abusers, Sexual Abuse: A Journal of Research & Treatment, or Sage Journals.

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